(Holly) Hello, everyone, and welcome to today's webinar,
Intro to Georgia Maternal Levels of Care Designation
with The Joint Commission.
Before we get started, I would like to go over a few items,
so, you know how to participate in today's event.
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I will now turn it over to Lindsay Parker Krivanek,
Associate Director, Hospital Certification at The Joint Commission.
(Lindsay) Thank you. Thank you so much, Holly.
I'm so glad everyone could join, thank you for joining.
Again, my name is Lindsay Krivanek, will just shorten it.
My name is Lindsay Krivanek,
I am one of the Associate Directors at The Joint Commission.
More importantly, I work with Georgia.
If you're on this call, I am your direct point of contact.
It is really great to talk to you today.
Today is Part 1 of a distinct webinar series
dedicated specifically to Georgia
and achieving Maternal Levels of Care Verification.
Our goal for today's presentation is to provide you with some background
on maternal levels of care from the Department of Health in Georgia
and the information you need to successfully apply for verification.
We are going to keep this short and sweet today
because we know you are all very busy people.
And with that said, I am going to introduce Erin Smith
with Georgia Department of Public Health, Maternal and Neonatal Designation program.
And here's Erin's contact information,
but we'll also share these slides with you so you'll have it as well.
So, go ahead Erin.
(Erin) Thank you, Lindsay. Good afternoon everybody.
I want to start by talking about
why maternal levels of care are so important to the state of Georgia.
Levels of maternal care provide guidelines
that help ensure that mothers and infants receive care
in a facility that has the personnel and the resources
appropriate for their level of risk.
We've found through research that failure to transfer care
to a hospital with an appropriate level of care
is a contributing factor in pregnancy-related deaths.
The Maternal Mortality Review Committee
recommends that hospitals should have a verified level of care
to ensure women are transferred to a higher level of care
when indicated.
Next slide, please.
Here, we see that, at a national level,
there have not been improvements
in pregnancy-related maternal mortality ratio for a decade,
despite the technology and other advancements in medical care.
Next slide.
Well, this is true in Georgia as well.
This slide shows the ratios of deaths in our state
since the beginning of our review process
and, as you can see,
they have remained fairly stable over time,
yet are not improving.
Next slide.
Here we see George's Leading Causes of Death by Race/Ethnicity.
As you can see, there are large racial and ethnic disparities
in pregnancy-related deaths.
Black women are 2.3 times more likely to die due to pregnancy
than white women.
And the leading causes of death for black women are not the same
as the leading causes of death for white women.
Next slide.
Just to give you a better sense of what not related deaths are,
this slide shows the leading causes of death in our state
for those categories.
It's important, however, to note that even a motor vehicle accident
could be determined to be pregnancy-related.
A couple of examples that would make the death pregnancy-related are,
if the death was due to a substance use disorder,
that was exacerbated by pregnancy
or even distractions from a child in the vehicle.
Homicides, as well, can be determined pregnancy-related
if the death was due to domestic violence,
which was exacerbated by the pregnancy.
Next slide, please.
This slide shows the timing of death in relation to pregnancy.
The orange bar represents the pregnancy related death.
As you can see, most pregnancy-related deaths
occurred during pregnancy or within 60 days postpartum.
Although there is a substantial number that occurred up to one year postpartum.
The yellow bar represents the pregnancy-associated,
but not related death.
Here you can see that more pregnancy-associated,
but not related, deaths occurred in the late postpartum period.
Next slide.
Preventability,
87% of our pregnancy-related deaths were determined to be preventable
between the years 2015 and 2017.
It's really important to know that this is not just preventable
based on the actions of the medical provider,
but also includes any reasonable change made by the patient or family,
the provider, the facility, the system or community factors.
It's certainly not uncommon to see a case
where the clinical interventions were appropriate
and all the possible preventability occurred at the community level.
Next slide.
Why do we want our hospitals to become verified?
The answer is simple.
We know that verification will clarify the level of maternal care
that a hospital can provide,
which ultimately will help improve maternal patient outcomes.
Next slide.
Because we feel so strongly about this program,
the Department of Public Health is offering to help with the cost.
This slide shows the fees per level of care.
For example, if you are seeking designation for a level of care 1,
the annual fee would be 2,000 dollars
and the on site fee for the survey is 2,275 dollars,
which brings the total cost for all three years to 8,275 dollars.
We will pay the first year annual fee along with the on site fee.
For level of care 1, the total cost for the hospital
would be 4,000 dollars over a three-year period.
Next slide, please.
Lastly, I'd like to share several common questions
that I've recently received.
The first one is, how do we know what level of care we are?
Well, Georgia recognizes level of care designation
based on the certificate of need,
which is assigned by the Department of Community Health.
You may either contact me
or your hospital's Department of Community Health representative
for this information.
The next question is,
if we have been accredited by another company,
can we still use The Joint Commission
for the Maternal Level of Care Designation?
The answer is yes.
It is OK to use the Joint Commission
Maternal Level of Care program for designation,
even if you have used another organization for accreditation.
Another question I've received is,
if we want to apply for a higher level of care,
how do we do this?
If you are level of care 1 or 2 and your seeking a higher level,
then you must contact your Department of Community Health representative
to begin the process.
If you are level of care 3 and are seeking level of care 4,
you can apply for this
if the standards for level of care 4 are met
when the hospital is surveyed.
Lastly, the common question I get,
is this a requirement or a recommendation from the Department of Public Health?
We feel this program will improve quality of care
to create better maternal outcomes in our state.
With that being said,
we highly recommend each hospital participate.
Currently, though, it is not a requirement.
I'm now going to pass this over to Lindsay,
so she can go over the process
for the Maternal Level of Care application.
(Lindsay) Wonderful, thank you so much, Erin.
Thank you for setting us up with that information.
As Erin mentioned,
there are four recognized levels of maternal care in Georgia.
I have on the screen a brief description of each.
I'd like to just point out to all of you,
if you are familiar with the Obstetric Care Consensus document
by ACOG and Society for Maternal-Fetal Medicine,
then you are familiar with the standards from The Joint Commission.
Our standards are directly derived from that document,
which helps ensure that all facilities are prepared
to provide risk-appropriate care
and of course, have a seamless process in place
when it comes to consultation and transfer when necessary.
We are going to dive more into the standards on Thursday,
in the second part of our series, but I did want to point out before levels.
Talking about the verification process, what are the steps?
Verification is new,
many of you on this call may not be familiar
with the steps in the process.
The good news is, it's fairly similar to the other processes
if you're familiar to The Joint Commission.
Ultimately, the very first step is just to contact me
and we will begin the process together.
So my role, as I mentioned in the introduction,
is really to serve as your point of contact
and make this as efficient as possible.
So during our time together,
we will discuss those standards and requirements,
I'll walk you through the application,
I'll make sure you have everything you need to apply.
We'll also talk about the onsite review,
I have some resources that I will be really excited to share with everyone
in addition to, on Thursday, in part two of these series,
Thursday we're going to talk a lot about onsite review prep,
so I hope you'll all join us for that in more detail.
But on these next slides,
I'm going to go through each one of these steps
in a little more detail with you.
Like I said, once we connect,
I will make sure you have access to the standards
and doing so, that's setting you up with a free 90-day trial
to the online standards known as E-dition.
Once you have access to these standards, then it's just performing a gap analysis
to see how your program currently compares.
On this slide, I have a screenshot of what E-dition looks like
and I know it's hard to see,
but I just wanted to point out that it will have the standard
and then you'll see, if you're at level 1, 2 or 3,
the specific requirements for each level.
But once we connect, I'll make sure you have access to these
and you'll be able to log into E-dition.
And then, a portion of the application
is to simply identify your Clinical Practice Guidelines.
On this slide, I have listed some very common sources for guidance
that you're probably all very familiar with,
such as ACOG, the blue book, A1.
So we will want to see that your policies and procedures
are based on this evidence-based literature.
And during the review, we'll just ask to see,
how you developed and built your policies from these sources.
So we will identify your Clinical Practice Guidelines together.
And then, one of the most exciting
and really impactful elements of verification, is this step,
it's your Performance Improvement goals.
I will walk you through the process
of answering these five Performance Improvement questions
that are designed to illustrate how you proactively identify areas
that you want to focus on for improvement.
So not only are we there to verify that you have the right personnel,
the resources, the capabilities, but we want to collaborate with you.
The reviewer will facilitate very meaningful conversation
related specifically to your PI goals from these questions
that are there to help enhance your organization.
Now, once you have these items,
which again, I'll help you gather,
we'll log into your hospital's Joint Commission Extranet site
to complete the application.
In terms of the application,
in adition to just telling us the names of your clinical practice guidelines
and responding to those five questions for the PI plan,
you'll want to establish a ready-date for the initial onsite review.
So the ready-date is,
you essentially tell us when you want us to come.
You're not hitting Submit on the application
and then we're calling you from the parking lot
and we're just all of a sudden there.
You will put in there your ready-date, we ask that your ready-date
is at least four to six months after you apply.
This just allows us to get time to get a reviewer scheduled
and also gives you additional time to prepare.
There is a 30-day notice.
So, again, we are not just showing up, we'll let you know 30 days in advance.
Some of you may be wondering,
"Well, what about the data, the performance measures?"
There are no performance measures,
there's not any data to submit for this verification program.
In the application, we will ask you about your volume,
so just telling us the number of deliveries
depending on which level you're applying for.
There may be other volume questions,
but the volume is not tied to any sort of eligibility requirements.
So once you submit your application and put in that ready-date,
we're going to schedule the review as close as possible
to the date that you indicate that you'll be ready
and also give you a 30-day notice.
We'll schedule that review, that's the last step.
If you are a level 1 and 2, I have listed on the screen here,
then you would expect you'll meet with one reviewer for one day,
if you are a level 3 and 4,
then you'll have two days with one reviewer.
And just while I'm talking about the verification review process,
something that I always like to point out no matter what,
is that our reviewers are the clinical experts
in the area that they review.
So the reviewer that comes on site to meet with you,
they're currently practicing in OB, they've been in your shoes before,
they are there to offer you best practices
from things they've seen all across the country.
So really utilize that time, that day or few days with them
as time to pick their brain, ask some questions.
They're not there, of course,
to just perform the review and the verification,
but they are there to be a resource for you,
going back to that performance improvement plan
and performance improvement goals.
So it's a really, really exciting time, really exciting time.
On this last slide--
I think I told everyone we're going to keep it short and sweet today.
On this last slide, I've mentioned it a few times,
we are having a part two to this webinar series
dividing up the time.
If you're interested in joining us,
please make sure you register for Thursday.
We are going to have our standards expert on the call
and one of our reviewers to go through the standards,
also talk about the review process and tips for onsite preparation.
And I believe that-- let's see if we have any questions,
which I think we might.
- (Lindsay) Let's see. - (Erin) Lindsay. It's Erin.
While you're looking at that,
I just wanted to add
that I am available
to help any of you with the process as well.
Lindsay and I talk, meet several times a week and...
I'm here to help all hospitals in the state with this process.
So please don't hesitate to reach out to me
if you need my assistance, you have any questions,
I'm definitely here for all of you.
(Lindsay) Yes, thank you. Thanks for including that also, Erin.
And as I mentioned, I have Erin's contact information,
it will be in the slide so everyone will have access to it.
My contact information is now listed on the screen as well.
Really long, Lindsay Parker-Krivanek,
I've got to figure out a way to shorten my name a little bit,
but feel free to reach out to either one of us
with questions and we will be here to make this very efficient.
I think I only have a few questions and these are great questions
because it's actually a few things that I just forgot to touch on.
The verification cycle, how long is it?
Maternal Levels of Care Verification is a three-year cycle.
I think it was discussed with the fees and the pricing
but it is a three-year cycle,
so you have your initial verification review,
and then your re-verification three years later.
That is a great question.
Then we have...
And yes, just to clarify,
if you are a level 3, if your CLN is a level 3,
and you are meeting The Joint Commission Verification Standards for a level 4,
then you can apply for a level 4 as a Regional Perinatal Center
or a level 4.
And then, do you have to be accredited by The Joint Commission
to apply for Maternal Levels of Care Verification?
No, you do not.
You do not have to be accredited through The Joint Commission
to apply for Maternal Levels of Care, that is open to everyone,
and I think,
that might be all the questions.
I know a lot-- Some of you I have already had calls with
and we've talked about
how long does it take to prepare for verification
and really, it's just going through the standards.
In Georgia, if you are a level 2,
then you're just looking at those level 2 standards and requirements
and just being self-assessing that you're meeting them.
Other than that, you have your PI goals and initiatives
that your organizations are all working on already,
so we'll jot those down and answer the five-question PI plan,
and then we'll just establish the clinical practice guidelines.
You could prepare for this in under a month
or, I don't want to put a strict timeline on it,
but the preparation for verification should not be very, very long.
And I think that might be all the questions.
Erin, can you think of anything else we've been talking
that we might want to touch on?
(Erin) I think we hit most of the points or all of the points that we discussed
that we wanted to on this session.
(Lindsay) Yeah.
(Erin) Lindsay and I are here for you all.
Just really don't hesitate to reach out with any questions.
(LIndsay) We are here to help and I hope again
that you'll join us on Thursday, we've allotted 30 minutes
to give you just the information that you need
for the onsite review, prep, tips,
just so you can understand the review process,
and we will have our clinical standards expert on the call
to help answer questions as well.
If you do not have the registration or you didn't register
or you didn't see it on the invite,
then reach out to either one of us and we'll make sure that you have it.
Well, that concludes everything from our end.
Thank you all for joining today
and I look forward to talking to each and every one of you.